Gynecology
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| On microscopic exam, these suggest presence of bacterial vaginosis | Clue cells (epithelial cells with irregular borders in clusters, very shiny)
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| Bacterial vaginosis requires 3 of 4 criteria. What are the 4 criteria? | Gray-white discharge, alkaline pH(>4.5) 2/2 suppression of lactobacilli, positive “whiff” test (fishy odor 2/2 anaerobes), clue cells on wet prep
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| Bacterial vaginosis is not considered an: | STD
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| Treatment for bacterial vaginosis | Metronidazole (500mg PO BID or 750 QD x7d) or clindamycin (300mg PO BID); or topical
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| Should you treat male partners of women with bacterial vaginosis? | No
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| Signs and Symptoms of Trichomonas vaginitis | Severe pruritus, musky greenish-yellow/frothy discharge, dysuria, dyspareunia, petechiae / strawberry cervix
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| Treatment for trichomonas vaginitis | Metronidazole 2gm PO x1 or 500mg BID x7d. Nonoxynol-9 helps prevent. Treat partners, look for other STDs
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| Treatment for yeast vaginitis | OTC imidazoles, oral fluconazole 150mg
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| Atrophic vaginitis often masquerades as what | Infection
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| Signs and symptoms of atrophic vaginitis | Pruritis/burning, vaginal dryness, dyspareunia, possibly spotting, pale/thin vaginal mucosa, loss of vaginal rugation; women w/o menses (decreased estrogen)
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| Bilateral Bartholin abscess said to be associated with what | Gonorrhea. Strep, E. coli, Chlamydia, anaerobes
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| Treatments for Bartholin gland abscess if not pointing | Antibiotic treatment may be successful
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| Treatment for Bartholin gland abscess | I&D and placement of Word catheter (left in for 1-2 weeks), marsupialization, needs to remain open to avoid recurrence
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| What organism is associated with toxic shock syndrome | S. aureus/endotoxins
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| CDC case definition of toxic shock syndrome | Fever >39C, hypotension (may ->shock in <48h), diffuse erythroderma, desquamation, involvement of at least 3 organ systems.
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| Treatment for toxic shock syndrome | Supportive, look for foreign body in vagina and remove, clindamycin and oxacillin/nafcillin, MRSA: clindamycin and vancomycin/linezolid
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| Pruritus, burning; cottage cheese discharge; dyspareunia | Yeast vaginitis
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| Chronic Bartholin cyst may be mistaken for: | acute abscess, esp perirectal abscess (more posterior)
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| DDx for vaginal discharge and pH: | Candida, BV, trich: itching & discharge. BV / trich: pH >4.5, Candida lower pH
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| Vaginitis DDx | candida (azoles), trich/BV (pH >4.5; flagyl); genital warts (podophyllum/ trichloroacetic acid)
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| Vaginitis sxs | vaginal discharge; Dyspaurenia; Dysuria; Urinary Frequency
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| Toxic shock syndrome: Skin | Erythroderma of skin / mucous membrane; diffuse, red, sunburn-like rash. Involves palms and soles. Conjunctival-scleral hemorrhage; later, pruritic maculopapular rash, desquamation
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| 6cm unilateral, mobile, tender adnexal mass | Tubo-ovarian abscess
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| If Candida is suspected clinically, but KOH is negative, suspect: | Candida glabrata
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| Cytolytic vaginitis is distinguished from BV by: | lower pH (3.5-4.5, 2/2 lactobacillus overgrowth)
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| Toxic shock syndrome recurrence | 30% of women with TSS have recurrence. Greatest risk in 1st 3 menstrual cycles after original episode
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| TSS mortality | 3-6%. Most common COD: ARDS, DIC, hotn/shock
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